Craniocerebral injury: first aid

The number of accidents every year is steadily growing - such a sad payment for the "blessings of civilization". Head injuries occupy one of the leading places among other injuries of peacetime. Every year, an average of 700 people die, and this figure is not yet the limit. The tragedy of the situation is that very early in life the best ones are gone: they are children (frequency craniocerebral injuries (TBI) in them are much higher than in adults) and young people, the so-called "color nation ".

Craniocerebral trauma is the damage to the skull and its contents of a mechanical nature, which are manifested by certain neurological symptoms. With head injuries, it is extremely important to provide first aid in a timely and competent way, so as not to lose precious time, that's why it is important for every person to know its basics.

Causes of head injuries

Because of what there are traumas of a head:

• road accidents;
• falling from a height;
• industrial injuries;
• domestic trauma;
• sports injuries.

Classification of craniocerebral injuries

The following injuries are distinguished by the nature of the injury:

• closed (trauma, in which the aponeurosis is not damaged, but bruises and injuries of the soft tissues of the head are possible);
• open (trauma, in which, in addition to the skin, the aponeurosis is necessarily damaged)
• penetrating (trauma, in which the integrity of the dura mater is broken).

Head injury clinic

Brain concussion.This most common head injury occurs in 80% of cases. Macro-structural pathology is not detected, and lesions are observed only at the cellular level, in connection with this concussion is a functionally reversible form. The patient is unconscious for a few seconds or minutes with the presence of amnesia, and is characterized by the appearance of nausea and vomiting. After the patient regained consciousness, he complains of dizziness, diffuse headache, double vision, sweating. Vital functions are not violated. Minor neurological disturbances manifest themselves in the form of asymmetry of tendon reflexes, small-scale nystagmus, which disappear in a week. The state of patients during the first week is significantly improved, and in CT and MRI there is no pathology.

Contusion of the brain.In this pathology, in contrast to concussion, there are gross macrostructural damage to the brain substance in the form of hemorrhage and destruction. Subarachnoid hemorrhage is a "companion" of such injuries. Fractures of the skull bones for them are also no exception, and the severity of the patient's condition directly depends on the severity of these manifestations. One of the main symptoms is swelling-swelling of the brain substance. Allocate the following types of this damage:

• mild severity. Patients may be unconscious for about 20 minutes. Complaints typical for head injuries - nausea, vomiting, dizziness, diffuse headache. Retro and anterograde amnesia are noted. Vital functions are not significantly disturbed, changes in the form of bradycardia and hypertension appear on the part of the cardiovascular system. Neurological symptoms are manifested in the form of pyramidal insufficiency, mild anisocoria, clonic nystagmus.
• moderate severity. The patient is unconscious for several hours. After the patient regains consciousness, there is multiple vomiting, pronounced amnesia, a violation of the psyche. Violations of vital functions are manifested in the form of persistent bradycardia, hypertension, tachypnea without violation of airway patency. In the neurological status there is nystagmus, asymmetry of the muscle tone and tendon reflexes, meningeal symptoms and pathological signs. Focal symptomatology is presented in the form of pupillary and oculomotor disorders, paresis of limbs, speech disorders.
• severe severity. The patient is in a coma for a long time (if not die) - a few weeks. Vital functions are grossly violated and pose a significant threat to life. On the foreground comes the stem symptomatology in the form of floating movements of the eyeballs, irregular rhythm and respiratory rate, bilateral mydriasis or miosis, divergence of eyeballs vertically or horizontally, hormoneotomy, pathological stop signs, paresis of limbs, convulsive seizures. Such patients are in a deep coma and the prognosis for life is very often unfavorable. With such bruises of the brain, fractures of the skull bones and massive subarachnoid hemorrhages are noted.

Compression of intracranial hematomas.Hematomas are formed above or under the dura mater as a result of depressed fractures of the bones of the skull. Clinically, they appear as a bruise of the brain, but they have their own peculiarities. After the restoration of consciousness in the patient is possible the so-called "light gap when to him for some time becomes easier, but with progression of brain edema and its dislocation, the patient again plunges into to whom.

First aid for head injury

Not only recovery, but also life largely depends on the quality of first aid and the rapid delivery of the victim to a medical institution. In this regard, any person who provides assistance, the first thing to do is to call an ambulance.

Algorithm for first aid:

• determine the presence of consciousness in the victim (try to wake up, evaluate the response to pain stimulation);
• examination of the type of injury (open or closed, the presence of bleeding, liquorrhea, or leakage of cerebrospinal fluid);
• determine the nature of breathing and palpitations (tachypnea or bradypnoe, the presence of aspiration, bradycardia or tachycardia, the presence of a pulse on the central and peripheral arteries);
• if an open craniocerebral injury is detected during examination, it is necessary to apply an aseptic bandage. If the bone fragments from the wound protrude or the brain tissue is visible, the bandage should be superimposed in a circle in the form of a ring;
• if the patient is unconscious, then it is necessary to check the patency of the airways (remove from the nasopharynx foreign body - blood clots, fragments of teeth; in the absence of breathing, it is necessary to initiate artificial respiration from the mouth to mouth);
• if there is no pulse on the main arteries, proceed to an indirect heart massage;
• in the presence of liquorrhea, nasal passages and the external auditory canal are covered with gauze turundas;
• if the victim is unconscious, he is laid on his side to prevent aspiration and asphyxia. If there is a suspicion of a vertebral fracture and a patient in consciousness, then it is laid on the back, fixing the cervical spine;
• Apply cold to the injury site;
• wait for the arrival of an ambulance. If such a patient has to be transported by passing transport, then on the road they control breathing and pulse every 10 minutes, maintain airway patency.

Categorically, you can not perform the following manipulations:

• It is impossible for the patient to be in a sitting position, even if he insists that everything is in order. Patients in a state of shock are not critical to their condition, do not adequately assess the situation, may be disoriented;
• without unnecessary need to change the location of the victim, since such movement can dramatically worsen the condition;
• if the wounds are bone fragments or foreign bodies - do not try to extract them, as this can lead to massive bleeding. It is necessary to carefully place an aseptic dressing in the form of a ring;
• Do not leave the patient unattended, as his condition can drastically change for the worse;
• Do not inject narcotic analgesics yourself for analgesia.

In conclusion, I would like to note that absolute inaction and failure to provide basic first aid leads to a lethal outcome in 70% of cases! Ignorance of the basics of first aid and inaction during the incident does not absolve responsibility, moreover, it is criminally punishable (Article 124, 125 of the Criminal Code of the Russian Federation).

Ministry of Health of Ukraine, training video on "Emergency medical care for craniocerebral trauma